DBS

Well, I observed a Deep Brain Stimulation surgery today, and it was amazing. This is one of the relatively few procedures during which the patient is totally awake and aware, which was really neat because it was clear that she was immediately improved. Today was the first of a two part procedure; first, you implant the electrodes in the brain, then a few days or a week later you implant the impulse generator and tunnel the leads from the electrodes to connect to the generator. Today started with Dr. Johans and Patrick, a Medtronic rep (he travels all around the country to assist with this surgery, and handles the business end of things), dtermining their plan of attack using a computer - they were nice enough to explain to me what was going on, which is good, because this is going to be one of the research topics I will be tackling this year. Two different kinds of MRI scans (T1 and T2) were overlayed with a CT scan in order to produce a map of the brain. They then planned the approach to insert the electrodes into the target areas without damaging major structures or causing bleeding. The computer then calculated the angles and settings for this approach, which were then dialed into a frame that is positioned over the patient's head. This frame is used to guide the electrodes into the targeted spots in the brain (as you can imagine, precision is very important). So, to make a long story short, a bur hole is drilled into the skull and the electrode is placed on each side (one at a time). After the electrode is in place, it is connected to a power source to check the placement. The patient today suffers from essential tremor, and as soon as each electrode was turned on, she was given a basic motor exam to test for improvement. When she first tried to touch her nose as part of the exam, she immediately started crying. Her tremor was all but gone (after tweaking the voltage a bit, it disappeared completely). She was overcome with emotion; she's had this tremor for almost 20 years, and it's had a terrible impact on her life. The whole thing was very touching, and it was very cool to see such a positive outcome for someone who hadn't even left the OR yet. Most people are totally out of it until a while later, so this was a nice change. I'm hoping I will get to see the second operation to implant and connect the impulse generator, but I'm really hoping that I will get to see her post-op in clinic to see how she's doing. Very cool stuff.